HomeMy Public PortalAbout10632 DAINES DR_Electrical__ APPLICAfION FOR LECTRIC PERMIT
COUNTY OF LOS ANGELES -
DEPARTMENT OF COUNTY ENGINEER eUtLDING
BUILDING AND SAFETY DIVISION ADDREss Q.
JOHN A. LAMBIE. COUNTY ENGINEER _
WILLIAM.A.JENSEN,SUP'T'OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NST.
NEAREST
/!
PERMIT FEES
OWNER. f.
ITEM NUMBER EACH FEE MAIL
OUTLE / $ 5 ADDRESS
LIGXTE RECEPTI SW. .10 O
LIGHTING FIXTURES 10 o CITY TEL-NO.
ELEC.RANGES CLO.DRYERS ELECTRICIAN
WATER HEATERS .50 ADDRESS ,
ELEC.SPACE HTRS. 015HWASHERS
CITY •TEL. NO.
GARBAGEDI5POSERS AUTO..
STATE 0
WASHERS STA.COOKING UNITS .25 LICENSE NO.
MOTORS: OVER INC. H:P. DISTRICTNO. IGROUPI ZONE PROCESSED Y
0— V. .25 / 7
2 .50 'INSPECTION RECORD
2— 5 1.00
5— is 1.50
15— 50 2.50
50-200 5:00 Lc aT
NO.TRANS
SIGNS:
NO.LAMPS
SERVICE 0-600V 1,00 U
SERVICE OVER 600V - 5.00
MISC,
WIRINGPERMIT 1.00 �J
FIXTURE PERMIT LOO
SUPPLEMENTARY PERMIT .50 -
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT -
ELECTRICAL WIRING. ��'
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED PND/OR WIRING m )//,
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT IA M THE LEGAL ER OFTHE ABOVE
DESCRIBED RESIDER T��jj P PESTY. POWER
SIGNATURE (/ UTILITYCO.NOTIFIED
OF'PERM ITTE FINAL A� i
®r /dALIDATION HURVETT,
SUPERVISING
U
MD CASH SUPERVISINN G ELECTRICAL,ENGINEER
[Ar S 9 3 O.2 DEC 1 9 2 D 7.0O
i YORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
6A663
I hereby 3f;irm that I have a certificate of consent to self insure,
or a cerci ftcate�of Vforker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS - BUILDING AND SAFETY DIV.
copy thereof(Sec.380000 jLAIDD...C.) n/
Policy No. II(iJ /c. /1C/'1Pompany Sy�7��jO FOR APPLICANT TO FILL IN JOB
AODRES6 (,'O��
❑ Certified copy is hereby furnished. _ New Residential Bldgs.&Pools. NO. .EACH FEE
�.
Certified copy is filed with the county building inspection 1&i--Family,Sq.F1.
$ $ LOCALITY _
T
tlepartmenLO Multi-family Sq.FL NEAREST
� p CROSS Si. M 0✓� W�
Date�����•-/6 Applicant /�,4hcniLA'/ Residential Swimming Pools ASSESSOR �!/ ,
MAP BOOK Yfd5 O 4> 1 PAGE 4/) O 1 PARCEL 6927
CERTIFICATE OF EXEMPTION FROM WORKERS' /J OWNER OR
COMPENSATION INSURANCE Outlets:Rec. Light Sw. �� FIRM NAME �•/- /
FIn' MAIL 20
LA
(This section need not be completed the work Involved by the Total No.I Additional 0 ADDRESS S
permit is for one hun Aretl dollars(5100O)or less.)
I certify that in the performance of the work for which this permit - CITY Tel.No.
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional tea'
/� ADDRESS
Date—Applicant, ESIDENFALL;P IAfVOES NOT OVER 3 HP. �O.7� C
NOTICE TO APPLICANT: If, after making.this is Certificate of CITY T.I.No.
Exemption,you should become subject to the Workers' Compensation OTHER APPLIA CES NOT OVER 3 HP.
provisions of the Labor Code, you must forthwith comply with such _ PFRMIr �"
provisions or this permit shall be deemed revoked.
Power Apparatus&Large Appliances APPLICANT nLQ x CVC�o L-IT (A/G:.
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,I or KVAR ADDRESS V {iL✓D .
I hereby'efflrm that I-am licensed under provisions of Chapter 9 Over 3 to 10 Ind.(commencing with Section 7000) of Division 3,of the Business and CITY �p �rH'�FY' Tel.
Professions Code,and my license is in full force and effect. Over 10 to 50 Ind. LICENSE OR
/J
Over 50 to 100 Ind. REG.NUMBER ` J Class. }
License Number 'I 7 LicClass
a
.Z Over 100 DISTRICT NO, ZR ESSED BY Q
� 3 .
Services Swbtl.,LM/�'C Pa el ards / G �� flit lC-f f.4j Q
-/-' •'D/n L 1 OlN✓3�9119 Ainp.Wall
O Q FINAL Q
Contractor m6pf DCa/&Coy� to � 442 DATE
❑ am exempt under 400-1000 Amp.Under 600 V
.- VALIDATION V
Over-1000 Amp.or Over 600 V FINAL UJId
B.BP.C.for this reason BRANCH CIRCUIT FEES- BY
Date: 15A,or 20A, 120V,Lighting or Recept. Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
El - 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits w2
SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT.i
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit n
I hereby affirm that I am exempt from the Contractor's License law 3303 139.40for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Cede): 1 ITEMS
❑ I,as owner of the property,will do the work and the structure Misc.Conduits 8 Conductors TOTAL 139 - 40
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ 1
and Professions Code). - MECK 1',9,40
CONSTRUCTION LENDING AGENCY - _ - . CiANGE - .00
1 hereby affirm that there is a construction lending agency for the _ -
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE _ (Sub-Total) (�
Civ. C.) - - 0000-0001 1/17/96
Lender's Name .PLAN CHECKING FEE 2 - 1 A1110*31
PERMIT ISSUING FEE 4_96
Lender's Address /
I certify that I have read this application and under penalty of purjury state TOTAL FEE
that the above information is correct. I agree to comply with all County -
ordinances and State laws regulating Electrical wiring,and hereby authorize
representatives of this County to enter upon the above-mentioned property
for inspectio oses. SEE REVERSE FOR EXPLANATORY LANGUAGE
/-17461
BIGNATU MITTEE DATE -